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A Reference Model Based Patient Management System: Opportunities and Challenges

Ravi Shankar and Sifat Islam Center for Systems Integration, Department of Computer Science and Engineering, Florida Atlantic University, Boca Raton, FL. A Reference Model Based Patient Management System: Opportunities and Challenges. Introduction.

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A Reference Model Based Patient Management System: Opportunities and Challenges

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  1. Ravi Shankar and Sifat Islam Center for Systems Integration, Department of Computer Science and Engineering, Florida Atlantic University, Boca Raton, FL A Reference Model Based Patient Management System: Opportunities and Challenges

  2. Introduction • CPS (Cyber-Physical Systems) is a recent NSF initiative that addresses the tight conjoining of and cooperation between computational and physical resources [1]. • Chronic diseases such as diabetes and coronary artery disease require regular monitoring and optimal management to enhance the quality of life for the patient. Such a patient management system (PMS) is an example of CPS. • It is further constrained by the need to be optimized to the individual patient, because of the biological variability and the underlying complex system.

  3. Introduction (2) • As the American population grows older, and the cost of chronic disease management worsens, better design of individual PMS systems, and better integration of such PMS systems into a holistic solution for the patient, will be necessary. • To start with, one can base a PMS design on the seven layer ISO OSI model [3]. • Such a model has been spectacularly successful for the Internet, a fully digital implementation; however, ISO has also developed such a seven-layer model for machine condition monitoring (MCM) [4].

  4. Method • We take the example of Glucose Metabolism in this paper-draft to explore the buildup of a multi-layer MCM-type model, and investigate ways to extend the model to make it more realistic. • NSF expects such a Cyber-Physical System (CPS) to enhance societal wellbeing (e.g., assistive technologies and ubiquitous health care monitoring and delivery). • The scope of this first report is limited to mapping glucose metabolism to an object oriented model, which is a prerequisite to building a viable multi-layer model.

  5. Method (2) • Abnormal glucose metabolism can lead to many large and small blood vessel diseases that can impact negatively one’s health and cause chronic conditions such as diabetes, high blood pressure, heart disease, kidney disease, and eye disease. • Medical researchers have uncovered many concurrent processes and feedback loops that are involved in the regulation of glucose. • Advances continue to be made in understanding glucose metabolism and linking system level effects to genetic, molecular, and genomic causes.

  6. Model • As a first step towards that goal, we propose to use OPM (Object-Process Methodology) [8] to model the interactions at the system level, and expand hierarchically to lower levels. • OPM combines formal yet simple graphics with natural language sentences to express the function, structure, and behavior of systems in an integrated, single model. • Objects and processes are the two main building blocks that OPM requires to construct models. • OPM has been used by other investigators to describe complex systems with many concurrent processes.

  7. OPD model depicting concurrencies of the glucose process

  8. OPD model for the disease sub-process

  9. OPD model for the insulin secretion sub-process

  10. Discussion • The OOD methodology, even with OPD modeling, does not allow easy integration of the information and generate a systemic perspective. • However, once they are documented with OPDs, it does become easy to go across the diagrams and evolve different perspectives. • Our goal is to relate these OPD diagrams to known acute and chronic systemic effects of Diabetes. • The intent is to find ways to translate OPD diagrams using concurrency modeling tools such as FSP and LTSA [7] to yield cause-and-effect type of outputs, specifically for Diabetes in our example.

  11. Conclusion • Human biology has features of hierarchy and near-decomposability that may, with certain modifications, allow one to exploit object-oriented modeling techniques. • This representation will allow practical reference models to be built that are amenable to computer implementation; this in turn will help build patient specific models that are reasonably accurate, fast, and have small memory footprints. • The mismatches will help us understand the limitations of object-oriented design in building self-adaptive systems. • Narrowing of the mismatches will help us move towards incorporating biological robustness into man-made cyber physical systems (CPS).

  12. References 1. NSF, Cyber Physical Systems (CPS), NSF 08611, http://www.nsf.gov/, Accessed 1/14/09 2. Rubin, H. Asking the Four Questions that Define the Cyber-Bio Interface, keynote speech, http://varma.ece.cmu.edu/cps/, Accessed 1/14/09 3. Wikepedia, OSI Layers, http://en.wikipedia.org/wiki/OSI_model 4. ISO, ISO13374-2, Condition monitoring and diagnostics of machines – Data Processing, Communication and Presentation - Part 2: Data-processing, http://www.iso.org/, 2007 5. Wikepedia, Health Level 7, http://en.wikipedia.org/wiki/HL7 6. Cengic, G.; Ljungkrantz, O.; and Åkesson, K. Formal Modeling of Function Block Applications Running in IEC 61499 Execution Runtime, IEEE International Conference on Emerging Technology and Factory Automation, Prague, Czech Republic, Sept 2006 7. Callbaut,W. Modularity: Understanding the Development and Evolution of Natural Complex Systems, Rasskin-Gutman, D., Eds, MIT Press, MA, 2005.

  13. 8. Dori, Dov. Object-Process Methodology: A Holistic Systems Paradigm, Springer, Berlin, 2002 9. Dori, Dov. Opcat Software, https://www.opcat.com/downloads/trial/, accessed in Nov ’08. 10. Magee, J. Concurrency: State Models and Java Programming, Kramer, J., 2nd Edition, Wiley, 2006. 11. Salway, J.G. Metabolism at a Glance, 3rdedition, Blackwell Publishing, 2004 12. Ashcroft, F.; and Rorsman, P.; Type 2 diabetes mellitus: not quite exciting enough?, Human Molecular Genetics, Vol. 13, Review Issue 1, January 2004. 13. National Center for Biotechnology Information, Introduction to Diabetes,http://www.ncbi.nlm.nih.gov/books/bookres.fcgi/diabetes/pdf_ch1.pdf, 3/14/09 14.Wilcox, G. Insulin and Insulin Resistance, Clin Biochem, Rev Vol 26, May 2005. 15. Freeman, H.; and Cox, R.D.; Type-2 diabetes: a cocktail of genetic discovery, Human Molecular Genetics, Vol.15, Review Issue No. 2, July 2006.

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